Changes in the Management of Vestibular Schwannoma within One Skull Base Unit: Review of 728 Cases over the Last 22 Years

Objective: Management of vestibular schwannomas presents therapeutic dilemmas. The aim of this study is to review changes in management strategies. Design: Retrospective chart review. The subjects were divided into four groups—groups I, II, III, and IV were for 1990–1994, 1995–1999, 2000–2004, and 2005–2011, respectively. Outcome Measures: Achievement of maximum tumor control with maximum neurological function preservation and patient satisfaction. Results: Group I included 91 cases with retrosigmoid (RS) in 49 cases (53.8%), translabyrinthine (TL) in 23 cases (25.3%), stereotactic radiosurgery (SRS) in 1 case (1.1%), and surveillance (W+S) in 8 cases (8.8%). Group II included 191 cases with RS in 97 cases (57%), TL in 46 cases (27%), SRS in 13 cases (7.7%), and W+S in 14 cases (8.3%). Group III included 144 cases with RS in 78 cases (54%), TL in 8 cases (5.5%), SRS in 31 cases (21.5%), and W+S in 27 cases (19%). Group IV included 302 cases with RS in 53 cases (17.5%), TL in 17 cases (6%), SRS in27 cases (9%), and W+S in 205 cases (67.5%). Maximum tumor control, maximum neurological function preservation, and patient satisfaction have improved from one group to another. Many variants have been studied, but the introduction of SRS and surveillance (W+S) with the reduction of the middle fossa approach was statistically significant. In group I, more than 75% of patients with VS were managed surgically (RS or TL). Twenty years later, this has completely reversed with 77% of cases in group IV managed with SRS or W+S.